Ergonomic Analysis of Otologic Surgery: Comparison of Endoscope and Microscope

Abstract

Objective: The comparative postural health of surgeons performing endoscopic and microscopic otologic surgeries has been a topic of active debate, with many nascent or anecdotal reports suggesting the latter encourages suboptimal ergonomics. Using inertial body sensors to measure joint angles, this study sought to objectively evaluate and compare the ergonomics of surgeons during endoscopic and microscopic otologic surgeries. Study Design: Prospective pilot trial. Setting: Large, multicenter, academic hospital system. Performed 21 otologic operations (10 endoscopic and 11 microscopic) in November 2020 and January 2021. All attendings were fellowship trained in otology/neurotology. Subjects: Eight otolaryngologists (four attendings and four residents) performing 21 otologic surgeries (11 microscopic and 10 endoscopic). Intervention: Approach to otologic surgery: endoscope or microscope. Main Outcome Measures: Surgeons' neck and back angles while wearing ergonomic sensors affixed to either side of each major joint, mental and physical burdens and pain after each surgery (via modified NASA Task Load Index).Results: Residents' necks (9.54°microscopic vs. −4.79°endoscopic, p = 0.04) and backs (16.48°microscopic vs. 3.66°endoscopic, p = 0.01) were significantly more flexed when performing microscopic surgery than when performing endoscopic surgery, although attending neck and back flexion were comparable during microscopic and endoscopic surgeries. Attendings reported significantly higher pain levels after operating microscopically than after operating endoscopically (0.13 vs. 2.76, p = 0.01). Conclusions: Residents were found to operate with significantly higher risk back and neck postures (as defined by the validated ergonomic tool, Rapid Entire Body Assessment) when operating microscopically. Attendings reported significantly higher levels of pain after operating microscopically versus endoscopically, suggesting that the suboptimal microscopic postures adopted earlier in training may pose an indelible risk later in a surgeon's career.

Outcomes After Exoscopic Versus Microscopic Type 1 Tympanoplasty

“…The primary benefits of the exoscope likely reside in improved ergonomics and in improved teaching capabilities. While improved ergonomics in otologic surgery with the exoscope have not been demonstrated yet, they have been demonstrated in total endoscopic ear surgery by 1) improved neck and back angles in residents and 2) lower pain levels in attendings (3). The postures utilized in exoscopic and endoscopic ear surgery are similar; thus, one may hypothesize that the ergonomics in exoscopic ear surgery will be improved as well.…”

“…Type 1 tympanoplasty is a successful surgical intervention for tympanic membrane perforation that has been traditionally described with the use of an operating microscope (1). In recent years, total endoscopic tympanoplasty has become increasingly more popular with proponents touting improved visualization (2), teaching capabilities, and ergonomics (3). In multiple systematic reviews and meta-analyses, graft success rates range from 85% to 90% for both the microscopic and endoscopic approaches, and audiometric outcomes are comparable (4,5).…”

Ergonomic learning curves on gynecological laparoendoscopic single-site (LESS) surgery

“…Previous ergonomic studies mostly concentrate on preventing musculoskeletal injury, physical burdens in endoscopy, laparoscopy [ 25 ] or robotic surgical [ 11 ]. Annie E [ 26 ] use inertial body sensors to measure joint angles to evaluate the ergonomics of surgeons during endoscopic and microscopic otologic surgeries. Our study builds upon these concepts, using the difficulty level of the operation as a starting point, and progressing from salpingectomy to ovarian cystectomy and myomectomy.…”

Ergonomics of Various Modalities for Ear Surgery

“…Arrighi‐Allisan et al found resident necks and backs were more flexed when using the microscope compared to the endoscope. 5 However, the exoscope represents an even newer modality now used in Europe and Asia. Exoscopes allow for the use of 3‐dimensional (3D) cameras to magnify the surgical field and project it onto a video tower.…”

“…Although a variety of ergonomic assessments exist, we elected to use the RULA due to its comprehensive evaluation, intuitive interpretation, and prevalence of use in previous ergonomic literature. 5 , 8 …”